Résumé
Background : Septal surgery is one of the most common surgical procedures performed by an Otorhinolaryngeal surgeon since ancient times. Various modifications in the approach, changing concept of conserving septal cartilage, use of an endoscope and good antibiotics to control postoperative infection have played a key role in controlling the complication rates but still, one thing which is mostly practiced worldwide is nasal packing in the postoperative period which is a nightmare for many patients, as the pain threshold varies from patient to patient. It also causes dryness of mouth, throat irritation, facial heaviness, headache, excessive watering from eyes, aural fullness. There is a lack of proper evidence to prove whether nasal packing really decreases postoperative hemorrhage as the incision is properly approximated and sutured. The main reason for nasal packing was an approximation of nasal septal flap thereby reducing the chances of septal Haematoma and stabilization of septal flap in the midline. The present study has been taken to study and compare postoperative nasal packing and modified quilting suture of the septal flap without the nasal pack. Material and Methods : This one-year prospective comparative study was conducted on 149 patients who underwent septoplasty with 3 months follow-up. One group had Postoperative nasal packing and the other had only modified septal flap suturing without the nasal pack. Results : Out of the total of 149 patients, 88 underwent nasal packing in the postoperative period and 61 patients had undergone suture of the nasal septal flap without nasal packing. A statistically significant value of VAS score was found in the non-packing group of 61 patients, where the average postoperative VAS score was 1.46 against 3.7 among the packing group of 88 patients. An unpaired t-test was applied and a value of 15.431 was obtained with a pvalue less than 0.001. No cases presented with septal perforation in the postoperative period in patients without a nasal pack and there were 2 cases (2.2%) of septal perforation in the nasal packing group. There was no significant bleeding in the postoperative period in both groups of patients. Conclusion : Stabilization of the nasal septal flap by modified quilting technique is better option after septoplasty with good comfort score.
Résumé
Introduction: Present study aimed to evaluates the cognitive status among dependent patients and effect of abstinence from alcohol for one month. Materials and methods: Study included 50 alcohol dependent male inpatients and a similar number of age and education matched controls. Specially designed semi-structured proforma was used to collect demographical data. Cognitive functions were evaluated by Post Graduate Institute of Medical Education and Research, Chandigarh Battery of Brain dysfunction (PGI-BBD). Assessment by similar method was done in both cases (at baseline and 1 month after abstinence/treatment) and controls. Data was analyzed by SPSS ver. 21.0. Results: Significant cognitive dysfunction was seen in all domains among alcoholics as compared to controls (p<0.05). Post-treatment/ abstinence improvement was seen in all domains except recent memory, mental balance, immediate and delayed recall, retention for similar and dissimilar pairs. Performance quotient impairment was seen in 40 (80%), 18 (36%) and 12 (24%) in pre-treatment, post-treatment and control group respectively. Further PQ evaluation revealed that mean scores of 69.54, 82.82 and 91.08 (p<0.05; all groups). Increase in years of consuming alcohol of study group is associated with more cognitive impairment in memory and intelligence. Conclusion: Present study had validated the assumption that there is significant cognitive impairment among alcohol dependent cases. These deficits can be detected with formal neuropsychological assessment Awareness of alcohol’s effects on cognition can help health-care providers in addressing the problem and instituting appropriate treatment.
Résumé
ABSTRACT Objectives: Magnetic resonance imaging has proven to be a valuable tool in the assessment of disc abnormalities. Two types of disc extrusion can be described according to the direction of herniated disc material: shoulder type and axillary type. Axillary disc herniation is described when the extruded disc fragment lies in the recess between the lateral border of cauda equina and medial to the nerve roots, while in the shoulder type the disc lies lateral to the nerve roots. It is very important to describe the type of disc herniation, as the surgical approach differs in each type. To the best of the authors' knowledge, no definite signs have been described in literature to date. This study aimed to address the accuracy of the kissing sign on MRI for he diagnosis of axillary disc herniation. Methods: The MRIs of 72 patients undergoing spinal surgery were prospectively evaluated for axillary disc herniation by a senior radiologist and experienced spinal surgeon using the kissing sign on MRI. The kissing sign was considered positive when the herniated disc material was in direct contact with the lamina and/or ligamentum flavum on axial images. Subsequently, all surgeries were performed by two independent surgeons and the actual type of disc herniation was documented. The accuracy of the results was statistically assessed. Results: The kissing sign on MRI was found to be 66.66% sensitive, 92.59% specific, and 76.38% accurate in detecting axillary disc herniation with significant correlation with the surgical findings. Conclusion: The type of disc herniation is an important parameter for patient selection in different surgical approaches. The kissing sign on MRI can be considered as an important tool for diagnosing axillary disc herniation due to its high specificity and accuracy.
RESUMO Objetivos: A ressonância magnética provou ser uma ferramenta valiosa na avaliação das anormalidades do disco. Dois tipos de extrusão de disco podem ser descritos de acordo com a direção do disco herniado: lateral e axilar. A hérnia de disco axilar é definida quando o fragmento do disco extruso encontra-se no recesso entre a borda lateral da cauda equina e medial às raízes do nervo, enquanto na hérnia lateral o disco posiciona-se lateralmente às raízes do nervo. A descrição do tipo de hérnia de disco é extremamente importante, pois a abordagem cirúrgica difere em cada tipo. Tanto quanto é do conhecimento dos autores, nenhum sinal definido foi descrito na literatura até o momento. Este estudo teve como objetivo abordar a precisão do sinal do beijo na RM no diagnóstico de herniação de disco axilar. Métodos: As RM de 72 pacientes submetidos à cirurgia da coluna vertebral foram avaliadas prospectivamente em relação à presença de hérnia de disco axilar por um radiologista sênior e cirurgião da coluna experiente com o sinal do beijo na RM. O sinal do beijo foi considerado positivo quando o material do disco herniado estava em contato direto com a lâmina e/ou ligamento amarelo em imagens axiais. Posteriormente, todas as cirurgias foram feitas por dois cirurgiões independentes e o tipo real de hérnia de disco foi documentado. A precisão dos resultados foi avaliada estatisticamente. Resultados: O sinal do beijo na RM apresentou 66,66% de sensibilidade, 92,59% de especificidade e 76,38% de precisão na detecção de hérnia de disco axilar com correlação significativa com os achados cirúrgicos. Conclusão: O tipo de hérnia de disco é um parâmetro importante para a seleção de pacientes em diferentes abordagens cirúrgicas. O sinal do beijo na RM pode ser considerado uma ferramenta importante para o diagnóstico de hérnia de disco axilar devido à sua alta especificidade e precisão.